Master Ophthalmology
for DHA
Access 30+ high-yield questions tailored for the 2026 syllabus. Includes AI-powered explanations and performance tracking.
Core Concepts
Ophthalmology covers the anatomy, physiology, and diseases of the eye. Key structures: cornea (refraction), lens (accommodation, cataracts), retina (photoreceptors, diabetic retinopathy (DR), AMD), optic nerve (vision transmission, glaucoma). Essential concepts: visual acuity (Snellen chart), intraocular pressure (IOP). High-yield conditions: cataracts (painless, progressive blur), glaucoma (optic neuropathy, visual field loss), DR (retinal microvascular damage), age-related macular degeneration (AMD - central vision loss), and common refractive errors.
Clinical Presentation
- Vision Loss: Sudden (CRAO, Retinal Detachment (RD), Optic Neuritis (ON)) vs. Gradual (Cataract, Glaucoma, AMD). Painful (Acute Angle-Closure Glaucoma, ON, Keratitis, Uveitis) vs. Painless (CRAO, AMD, DR). Central (AMD, Macular Edema) vs. Peripheral (Glaucoma). Transient (Amaurosis Fugax).
- Red Eye: Conjunctival injection (conjunctivitis) vs. Ciliary flush (keratitis, uveitis, acute glaucoma). Associated discharge, itching, photophobia.
- Eye Pain: Sharp (corneal abrasion) or deep/aching (scleritis, orbital cellulitis, acute glaucoma).
- Diplopia (Double Vision): Monocular (refractive error, cataract) vs. Binocular (cranial nerve (CN) palsies, orbital disease).
- Floaters & Flashes: Sudden onset suggests vitreous detachment or retinal tear/RD.
- Photophobia: Common in corneal abrasions, keratitis, uveitis, acute glaucoma.
- Systemic: Diabetes (DR), Hypertension (Hypertensive Retinopathy), Autoimmune (Uveitis, Scleritis), Multiple Sclerosis (ON).
Diagnosis (Gold Standard)
Diagnosis: comprehensive exam. Visual Acuity (Snellen) is baseline. Slit Lamp Biomicroscopy examines anterior segment (cornea, lens) and anterior vitreous. Fundoscopy (direct/indirect) evaluates retina, optic nerve head (ONH), vasculature; crucial for DR, AMD, glaucoma. Tonometry (Goldmann applanation is gold standard) measures IOP. Perimetry (Visual Field Testing) identifies field defects (glaucoma, neuro-ophthalmic). Optical Coherence Tomography (OCT) (gold standard) for macular diseases (e.g., DME, wet AMD) & glaucoma progression. Fluorescein Angiography visualizes retinal circulation (DR, wet AMD). Gonioscopy evaluates anterior chamber (AC) angle (distinguishes glaucoma types).
Management (First Line)
First-line management:
- Refractive Errors: Corrective lenses (glasses, contacts). Surgical: LASIK/PRK.
- Cataracts: Phacoemulsification + IOL implantation.
- Open-Angle Glaucoma: Topical prostaglandins, beta-blockers (IOP lowering). Laser trabeculoplasty (SLT) or trabeculectomy if medical therapy fails.
- Acute Angle-Closure Glaucoma: Medical emergency. Topical IOP-lowering drops, oral acetazolamide. Definitive: Laser peripheral iridotomy (PI).
- Diabetic Retinopathy: Panretinal photocoagulation (PRP) for proliferative DR; anti-VEGF injections for DME & proliferative DR. Strict systemic control.
- Wet AMD: Intravitreal anti-VEGF injections.
- Bacterial Conjunctivitis: Topical broad-spectrum antibiotics.
- Corneal Abrasion/FB: Removal, topical antibiotics, cycloplegics.
- Retinal Detachment: Urgent surgical repair (vitrectomy, scleral buckling).
Exam Red Flags
- Sudden, Painful Vision Loss: Acute A-C glaucoma, ON, keratitis, uveitis.
- Sudden, Painless Vision Loss: CRAO (emergency), CRVO, RD, Vitreous Hemorrhage.
- Severe Eye Pain with Headache/Nausea/Vomiting: Suggests acute A-C glaucoma.
- Fixed, Mid-Dilated Pupil: Acute A-C glaucoma, CN III palsy.
- Proptosis (pain, restricted EOMs, fever): Orbital cellulitis (emergency; vision loss, cavernous sinus thrombosis (CST) risk).
- New Binocular Diplopia: CN palsies, myasthenia, intracranial pathology.
- Chemical Eye Injury: Immediate, copious irrigation.
- Globe Rupture/Penetrating Injury: Peaked pupil, hyphema, reduced VA. Shield eye, STAT referral.
- New Onset Floaters, Flashes, or 'Curtain' Effect: Retinal detachment – urgent referral.
- Relative Afferent Pupillary Defect (RAPD): Unilateral ON/retinal disease (e.g., ON, CRAO, severe RD).
Sample Practice Questions
A 68-year-old female with a history of hypertension and hyperlipidemia presents with sudden, painless monocular vision loss in her right eye that occurred upon waking this morning. Fundoscopic examination reveals diffuse retinal hemorrhages, dilated and tortuous veins, and cotton wool spots in the right eye. The left eye appears normal. What is the most likely diagnosis?
A 68-year-old female presents to the emergency department complaining of sudden onset severe pain in her right eye, headache, nausea, and blurred vision over the past few hours. She reports seeing 'halos' around lights. On examination, the right eye is red, the cornea is hazy, and the pupil is mid-dilated and fixed. Intraocular pressure (IOP) is 55 mmHg in the right eye (normal 10-21 mmHg) and 18 mmHg in the left. Which of the following is the most likely diagnosis?
A 28-year-old male presents with sudden onset of redness, a gritty sensation, and profuse mucopurulent discharge in his right eye for 2 days. He reports his eyelids are often stuck together in the morning. Vision is mildly blurred due to discharge but clears with blinking. There is no pain or photophobia. The left eye is unaffected.
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